Provider Demographics
NPI:1467007138
Name:WHITE, KANADA BRELANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KANADA
Middle Name:BRELANE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KANADA
Other - Middle Name:BRELANE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1216 BURGANDY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4485
Mailing Address - Country:US
Mailing Address - Phone:432-634-2786
Mailing Address - Fax:
Practice Address - Street 1:5214 THOMASON DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6000
Practice Address - Country:US
Practice Address - Phone:432-699-1261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist